Traumatic Brain Injury in the War Zone

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An article in the New England Journal of Medicine entitled “Traumatic Brain Injury in the War Zone” details the experiences of a supply officer with a US Army Stryker Brigade after suffering a head injury in Northern Iraq in a convoy transporting Iraqi volunteers to Mosul for military training.

The officer reported remembering that the streets were unusually quiet, and he remembered making a radio call to others in the convoy warning them that something might happen. After the vehicle he was traveling in was struck by an improvised explosive device (IED), he remembers having thoughts of why he couldn’t see or hear and remembers wondering where he was. The blast had thrown him from his vehicle, causing a fractured skull and severe contusion of the left fronto-temporal area of his brain.

As one of the most damaging and dangerous consequences of Traumatic Brain Injury (TBI) is brain edema causing swelling of the brain, neurosurgeons performed a craniectomy removing a large piece of skull from the left temporal region, allowing the brain room to swell without being constrained. The compression of the brain in a confined space after a head injury can lead to severe complications, including death.

The next the officer remembers was waking up ten days later at the Walter Reed Hospital. Following treatment, including cognitive and speech therapy, this particular officer made a good recovery, but the article points out that others with similar head injuries do not do as well.

Researchers at the Roskamp Institute (Institute) have previously shown the recovery after TBI is partly controlled by a gene called the APOE gene. Variations in the APOE gene determine whether one will make a good or slow recovery after TBI. It is of interest to note that the same gene determines the risk of developing Alzheimer’s disease in older age groups. APOE may therefore be a general repair gene and current research at the Institute is examining the role of APOE and how it can influence recovery after head injury.

The Institute researchers hope to understand how APOE can, on the one hand increase rates of repair, or on the other hand, encourage degeneration after head injury. Such understanding may lead to the development of new treatments after TBI and may assist young officers, such as the one mentioned here, who suffer the effects of TBI while doing their duty.

This program is funded by the Department of Defense (DoD) as part of the DoD’s general strategy to find new treatments for soldiers who suffer from TBI. TBI is a common occurrence in the civilian population too and treatments developed for military personnel are likely to be extended very quickly for use in civilian population if shown to be successful.